The paravertebral block (PVB) is a regional anesthetic technique used to provide analgesia for thoracic and abdominal pain, along with surgical anesthesia [1]. The technique has transitioned from relying on anatomical landmarks to a more effective and safe ultrasound-guided approach [2]. In Australia, PVBs are covered by the Medicare Benefi ts Schedule (MBS), a catalogue of services that are subsidized by the Australian Government, under code 18276. The aim of this study is to assess the evolving trends in the utilization of PVBs in Australia over the last 25 years.

We conducted a retrospective analysis of patients of all ages who underwent PVBs via Medicare Australia data from July 1998 to June 2023. MBS 18276 claims over the 25-year period according to various patient demographics including age and gender, were extracted from the Medicare Statistics Human Services website into a Microsoft Excel spreadsheet. Statistical methods including joinpoint regression analysis were applied to elucidate trends.

Over the past 25 years, 398,509 PVBs were subsidized by Medicare. The predominant age group receiving PVBs was 75–84 years (6,533 PVBs per 100,000 population) followed by 65–74 years (5,290 PVBs per 100,000 population) seen in Figure 1. Females had a higher PVB utilization rate than males (2,029 vs. 1,478 PVBs per 100,000 population; ratio of 1.37:1). There was an 18-fold increase in the annual rate of PVBs, from 15 to 274 per 100,000 over the past 25 years. A four joinpoint model best fi ts the data (Figure 2). There was an exponential increase of 247% in recent years from 2019–2022 in the usage of PVBs compared to only a 69% increase in the decade prior (2009–2018). Over the 25 years, the highest increase was in the 85+ age group for females (22.9- fold) and 75–84 years for males (24-fold). The 25–34 age group experienced the highest increase in the last fi ve years. Males experienced a faster rate increase in blocks over the last fi ve years than females (248% vs. 195%). The total Medicare subsidy over the 25 years amounted to $39,774,234 (Australian dollars).

Figure 1. Paravertebral Blocks per 100,000 Population in Different Age Groups Over 25 Years

Figure 2. Joinpoint Analysis of Annual Incidence of Paravertebral Blocks Over 25 Years

This study highlights a significant increase in PVB usage over the last 25 years in Australia, particularly pronounced in recent years. Factors contributing to this trend may include the advancements in ultrasound-guided techniques and the preference for regional anesthesia during the COVID-19 pandemic aimed at minimizing aerosol-generating procedures and complications to patients [1,3,4]. This increase may also refl ect the increasing incidence of traumatic rib fractures; however, this has yet to be explored in literature, and due to the absence of data on specifi c PVB indications of MBS claims, future studies are required to confi rm this. The higher PVB rate in older patients reflects the adaptation of pain management practices more suitable for the older population [5]. A limitation of this study is that the data may not capture all instances of PVB usage, although it likely accounts for the majority. Medicare is Australia’s universal healthcare system covering Australian citizens, permanent and some temporary residents, and visitors from countries holding a Reciprocal Health Care Agreement with Australia. This includes patients receiving PVBs in private settings who are reimbursed partially by Medicare. Overseas visitors ineligible for Medicare are not included in the data; however, their numbers are likely low. This pioneering study on Australian PVB trends highlights the need for future research into gender-specifi c healthcare patterns. Moreover, considering the signifi cant Medicare subsidy, the cost-effectiveness of PVBs should be studied.

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All authors contributed to the conceptualization, literature search, data collection and analysis, manuscript writing and editing.

None. Data is publicly available on Medicare Australia website and deidentified.